Long-Term Care Workforce Support Act
A BILL
To support the direct care professional workforce, and for other purposes.
Sec. 2 Findings and purposes
Findings— Congress finds the following:
The nearly 5,000,000 direct care professionals in the United States play a vital role in supporting the health, well-being, and independence of older individuals and people with disabilities.
The United States faces a growing crisis in its direct care professional workforce at the same time that demand for services is rising at unprecedented rates.
There will be an estimated 9,300,000 total direct care professional job openings from 2021 to 2031, including new jobs to support the growing number of people who need care and to fill the jobs of such professionals leaving the direct care professional workforce.
Workforce turnover and shortages have a direct impact on older individuals, people with disabilities, and their families who suffer because they cannot get the high-quality care that they need and deserve.
The median hourly wage for all direct care professionals in 2022 was only $15.43, with home care workers earning the least.
One in 8 direct care professionals live in poverty and three quarters earn less than the average living wage in their State.
Forty-six percent of direct care professionals rely on public assistance, such as Medicaid, food and nutrition assistance, or cash assistance.
Direct care professionals report high levels of burnout and professional fatigue from their physically and emotionally demanding work, lack of respect for the essential, skilled care they provide, and lasting trauma from battling the COVID–19 pandemic, all of which further drives high turnover.
The long-term care industry is struggling to hire and retain direct care professionals, with a national turnover rate between 77 to nearly 100 percent.
Ninety-two percent of nursing home respondents and nearly 70 percent of assisted living facilities surveyed report significant or severe workforce shortages.
More than half of nursing homes surveyed in 2022 reported that they limited new patient admissions due to staffing shortages.
A survey of State home and community-based services (referred to in this section as “HCBS”) programs showed that every State reports a shortage of workers, and in 43 States, some HCBS providers have closed permanently.
The low-quality of direct care professional jobs reflects and perpetuates the racial and gender inequities faced by direct care professionals, who are disproportionately women, immigrants, and people of color.
Efforts to support the direct care professional workforce have focused on specific care settings, even though these issues are widespread across the long-term care landscape and direct care professionals across settings face similar challenges of low wages, few benefits, limited training and support, worker exploitation, and a lack of meaningful career ladders.
Stabilizing, growing, and supporting the direct care professional workforce across the continuum of long-term care is essential to ensuring a strong, qualified pipeline of workers, and improving the lives of direct care professionals and the older individuals, people with disabilities, and the families and communities that they support.
Purposes— The purposes of this Act are as follows:
To increase the capacity of the direct care professional workforce to ensure that older individuals, people with disabilities, and their families receive the services they need in the settings of their choice as they deserve to live healthy, independent lives.
To increase compensation so that direct care professionals are paid a living wage and have access to essential job benefits, and so that direct care professional jobs are good jobs.
To ensure that direct care professionals are treated with respect, provided with a safe working environment, protected from exploitation, and fairly compensated for the skilled work they do.
To improve access to and quality of long-term care, including collecting meaningful and actionable data on the direct care professional workforce and the people they support.
To eliminate the race, gender, sexual orientation, age, and gender identity disparities that exist across the direct care professional workforce.
To strengthen the direct care professional workforce in order to support the 53,000,000 unpaid family caregivers who are often providing complex services and supports to their loved ones who are older individuals and people with disabilities in their homes, communities, and residential settings.
Sec. 3 Definitions
In this Act:
Activities of daily living— The term activities of daily living means basic, personal, everyday activities, including tasks such as eating, toileting, grooming, dressing, bathing, and transferring.
Aging and disability resource center— The term Aging and Disability Resource Center has the meaning given such term in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002).
Apprenticeship program— The term apprenticeship program means an apprenticeship program registered under the Act of August 16, 1937 (commonly known as the “National Apprenticeship Act”; 50 Stat. 664, chapter 663; 29 U.S.C. 50 et seq.), including any requirement, standard, or rule promulgated under such Act.
Appropriate committees of Congress— The term appropriate committees of Congress means—
the Committee on Finance of the Senate;
the Committee on Health, Education, Labor, and Pensions of the Senate;
the Special Committee on Aging of the Senate;
the Committee on Ways and Means of the House of Representatives;
the Committee on Energy and Commerce of the House of Representatives; and
the Committee on Education and Workforce of the House of Representatives.
Area agency on aging— The term area agency on aging has the meaning given such term in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002).
Assisted living facility— The term assisted living facility means an adult care facility that—
is a residential care setting licensed and regulated by the State in which the facility is located (or, if there is no State law providing for such licensing and regulation by the State, by the municipality or other political subdivision in which the facility is located);
makes available to residents supportive services to assist the residents in carrying out activities of daily living;
provides 24-hour on-site monitoring, personal care planning, food services, and personal care; and
may make available to residents home health care services, such as nursing and therapy; and
provides dwelling units for residents, each of which may contain a full kitchen, bedroom, and bathroom, and which includes common rooms and other facilities appropriate for the provision of supportive services to the residents of the facility.
Certified nursing assistant— The term certified nursing assistant means a nurse aide who has completed a State-approved training and competency evaluation program.
Commerce— Except as provided in section 331, the term commerce has the meaning given such term in section 3 of the Fair Labor Standards Act of 1938 (29 U.S.C. 203).
Community or technical college— The term community or technical college means a public institution of higher education at which the highest degree that is predominantly awarded to students is an associate’s degree, including Tribal Colleges or Universities receiving grants under section 316 of the Higher Education Act of 1965 (20 U.S.C. 1059c) that offer a 2-year program for completion of such degree and State public institutions of higher education that offer such a 2-year program.
Developmental disability— The term developmental disability has the meaning given such term in section 102 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15002).
Direct care professional— The term direct care professional means—
a personal or home care aide;
a home and community-based services worker;
a direct support professional;
a certified nursing assistant;
a nurse aide or nursing assistant;
a respite care provider;
a paid family caregiver;
a home health aide;
a private duty nurse; or
any other individual providing relevant services (as determined by the Secretary of Health and Human Services) for compensation, in the course of the profession of such individual, at a long-term care setting to a resident of such setting.
Direct care professional manager— The term direct care professional manager means a person who is a manager, or supervisory staff, with coaching, training, managerial, supervisory, or other oversight responsibilities of direct care professionals.
Direct care professional workforce— The term direct care professional workforce means the broad workforce of direct care professionals across all long-term care settings.
Disability— The term disability, except as provided in paragraph (10), has the meaning given such term in section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102).
Domestic partner—
In general— The term domestic partner, with respect to an individual, means another individual with whom the individual is in a committed relationship.
Committed relationship defined— The term committed relationship for purposes of subparagraph (A)—
means a relationship between 2 individuals, each at least 18 years of age, in which both individuals share responsibility for a significant measure of each other’s common welfare; and
includes any such relationship between 2 individuals, including individuals of the same sex, that is granted legal recognition by a State or political subdivision of a State as a marriage or analogous relationship, including a civil union or domestic partnership.
Employ— The term employ has the meaning given the term in section 3 of the Fair Labor Standards Act of 1938 (29 U.S.C. 203).
Employee; employer— Except as provided in section 331, the terms employee and employer have the meanings given such terms in section 3 of such Act.
Home and community-based services— The term home and community-based services means any of the following (whether provided on a fee-for-service, risk, or other basis):
Home health care services authorized under paragraph (7) of section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)).
Personal care services authorized under paragraph (24) of such section.
PACE services authorized under paragraph (26) of such section.
Home and community-based services authorized under subsections (b), (c), (i), (j), and (k) of section 1915 of such Act (42 U.S.C. 1396n), such services authorized under a waiver under section 1115 of such Act (42 U.S.C. 1315), and such services provided through coverage authorized under section 1937 of such Act (42 U.S.C. 1396u–7).
Case management services authorized under section 1905(a)(19) of the Social Security Act (42 U.S.C. 1396d(a)(19)) and section 1915(g) of such Act (42 U.S.C. 1396n(g)).
Rehabilitative services, including those related to behavioral health, described in section 1905(a)(13) of such Act (42 U.S.C. 1396d(a)(13)).
Such other services specified by the Secretary of Health and Human Services.
Home and community-based services setting— The term home and community-based services setting means a setting where home and community-based services authorized under State options described in subsection (c) or (i) of section 1915 of the Social Security Act (42 U.S.C. 1396n) or, as relevant, demonstration projects authorized under section 1115 of such Act (42 U.S.C. 1315), are provided to individuals enrolled for medical assistance under a State plan under title XIX (or under a waiver of such a plan).
Home and community-based services worker— The term home and community-based services worker—
means an individual who provides home and community-based services for compensation; and
may include individuals described in subparagraph (A) who are physical therapists, occupational therapists, or speech or language therapists.
Indian Tribe; Tribal organization— The terms Indian Tribe and Tribal organization have the meanings given such terms in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).
Institution of higher education— The term institution of higher education means—
an institution of higher education defined in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001); or
an institution of higher education defined in section 102(a)(1)(B) of such Act (20 U.S.C. 1002(a)(1)(B)).
Instrumental activities of daily living— The term instrumental activities of daily living means tasks that are not necessary for fundamental functioning, but allow an individual to live independently in a community of daily living. Such tasks include—
housekeeping and room cleaning;
meal preparation;
taking medications;
laundry;
transportation;
shopping for groceries, clothing, or other items;
managing communications, such as using the telephone;
managing finances;
writing letters; and
obtaining appointments.
Local educational agency— The term local educational agency has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
Long-term care services— The term long-term care services means any services provided by a direct care professional in a long-term care setting.
Long-term care setting— The term long-term care setting means—
a nursing home;
a home and community-based services setting;
an assisted living facility;
an intermediate care facility;
a State home, as defined in section 101(19) of title 38, United States Code;
a Tribal nursing home operated pursuant to an Indian health program (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603));
a private home;
a respite setting; or
any other setting in which an individual provides relevant services (as determined by the Secretary of Health and Human Services), in the course of the profession of such individual, to a resident of such setting.
Medicaid program— The term Medicaid program means, with respect to a State, the State program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (including any waiver or demonstration under such title or under section 1115 of such Act (42 U.S.C. 1315) relating to such title).
Nurse aide— The term nurse aide has the meaning given such term in section 1919(b)(5) of the Social Security Act (42 U.S.C. 1396r(b)(5)).
Nursing assistant— The term nursing assistant means an individual who provides or assists with the basic care or support of a patient under the direction of onsite licensed nursing staff, which may include performing duties such as—
monitoring of the health status, feeding, bathing, dressing, grooming, toileting, or ambulation of patients or residents in a health facility or nursing home; and
medication administration and other health-related tasks of patients in a health facility or nursing home.
Nursing home— The term nursing home means—
a nursing facility as defined in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)); or
a skilled nursing facility as defined in section 1819(a) of such Act (42 U.S.C. 1395i–3(a)).
Older individual— The term older individual has the meaning given the term in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002).
Personal or home care aide—
In general— The term personal or home care aide means an individual who helps older individuals and people with serious illness, physical disability, cognitive impairment (including Alzheimer’s disease or other dementias, a developmental disability, or another disability involving a mental impairment) to live in their own home or a residential care facility (such as a nursing home, assisted living facility, or any other facility the Secretary of Health and Human Services determines appropriate that is not described in subparagraph (B)(i)) by providing personal care services for compensation.
Personal care services— For purposes of subparagraph (A), the term personal care services means assistance or services—
provided to an individual who is not an inpatient or resident of a hospital or institution for mental disease; and
that enable the recipient to accomplish activities of daily living or instrumental activities of daily living.
Secondary school— The term secondary school has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
Self-directed care professional— The term self-directed care professional (also known as an “independent provider”)—
means a direct care professional who is employed by an individual who is an older individual, a person with a disability, or a representative of such older individual or person with a disability, and such older individual or person with a disability has the decision-making authority over certain supports and services provided by the direct care professional and takes direct responsibility to manage those supports and services; and
includes paid family caregivers.
State— The term State, except as otherwise provided in this Act, has the meaning given such term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
State educational agency— The term State educational agency has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
Urban Indian organization— The term urban Indian organization has the meaning given the term in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).
Workforce Innovation and Opportunity Act terms— The terms career pathway, career planning, in-demand industry sector or occupation, individual with a barrier to employment, local board, on-the-job training, recognized postsecondary credential, region, and State board have the meanings given such terms in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102).
Work-based learning— The term work-based learning has the meaning given such term in section 3 of the Carl D. Perkins Career and Technical Education Act of 2006 (20 U.S.C. 2302).